Healthcare Provider Details

I. General information

NPI: 1811365802
Provider Name (Legal Business Name): SOUTH TEXAS UROGYNECOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 MADISON OAK DR SUITE 570
SAN ANTONIO TX
78258-3943
US

IV. Provider business mailing address

540 MADISON OAK DR SUITE 570
SAN ANTONIO TX
78258-3943
US

V. Phone/Fax

Practice location:
  • Phone: 210-402-3700
  • Fax: 210-402-3892
Mailing address:
  • Phone: 210-402-3700
  • Fax: 210-402-3892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberPO145
License Number StateTX

VIII. Authorized Official

Name: DR. ALEJANDRO D TRESZEZAMSKY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 210-402-3700